Early treatment of a shoulder dislocation eliminates the stretch and compression of nerves and muscle, and reduces the amount of muscle spasm that must be overcome to reduce the shoulder. Although some dislocations may be reduced without medication, in many instances, the patient is lightly anaesthetized or given a muscle relaxant. The administration of pain medication and/or the depth of anesthesia depends on the amount of trauma that produced the dislocation, the duration of the dislocation, how many times the patient has previously dislocated, whether the dislocation is locked, and to what extent the patient can voluntarily relax his shoulder muscles.
There are several techniques for reduction of a shoulder dislocation, which include: leverage methods, such as Hippocrates' technique and Kocher's technique; Stimson's technique; Milch's Technique; traction-countertraction methods, including Matsen's preferred method; and scapular manipulation.
Kocher's technique was first described in Egyptian hieroglyphs 3,000 years ago. For this maneuver, the humeral head is levered on the anterior surface of the shoulder cavity and the long shaft of the humerus is levered against the chest wall until the reduction is complete. Hippocrates' technique is useful when only one person is available to reduce the shoulder. In this technique, longitudinal traction of the arm is performed and countertraction is applied to the axilla, usually with the heel of the foot of the physician. The traction of the arm is slow and gentle, and the arm may be gently rotated internally and externally to disengage the head of the humerus. Leverage methods, such as Kocher's and Hippocrates' techniques, are often discouraged because of the increased incidence of humeral shaft fractures, injuries to the shoulder capsule, and axillary nerve damage.
Using Stimson's Technique, a patient lies prone on a bed or table with the dislocated arm hanging over the edge of the bed or table. Traction is provided by appropriate weight (e.g., 5 pounds) attached to the wrist of the dislocated arm, which hangs free over the edge of the table. The weighted arm dangles, placing constant traction on the shoulder, which gradually overcomes the muscle spasm. Analgesia and/or muscle relaxation is also recommended for use with this technique. Reduction of a dislocated shoulder using the Stimson technique usually requires 15 to 30 minutes; however, if reduction does not occur spontaneously, reduction may be achieved by rotating the arm internally and externally to disengage the head of the humerus.
Milch's Technique requires a physician to abduct the dislocated arm of the patient with one hand while applying pressure to the humeral head with the other hand. When the patient's arm is fully abducted, external rotation and traction are applied, and the head of the humerus is gently pushed back into place. A modified version of this technique may also be performed with the patient in the prone position.
The traction-countertraction method requires two practitioners. One practitioner applies axial traction to the dislocated arm by pulling the affected limb down and laterally at approximately 45 degrees. A second practitioner applies countertraction using a sheet wrapped under the arm and around the chest while the shoulder is gently rotated internally and externally by the first practitioner to disengage the humeral head from the glenoid.
Matsen's preferred method of anterior reduction also utilizes a form of traction-countertraction. As the patient lies supine, a sheet is wrapped around the patient's chest, which is then wrapped around one practitioner's waist for countertraction. A second practitioner stands on the side of the dislocated shoulder near the patient's waist with the elbow of the dislocated shoulder bent to 90 degrees. A second sheet, tied loosely around the second practitioner's waist and looped over the patient's forearm, provides traction while the second practitioner leans back against the sheet while grasping the forearm. Steady traction along the axis of the arm usually causes reduction.
In scapular manipulation, the patient sits upright, and one practitioner provides forward traction on the dislocated arm. A second operator approached the patient from behind and manipulates the scapula by pivoting it clockwise for a right shoulder and counter clockwise for a left shoulder. This is performed by rotating the inferior tip of the scapula medially with both thumbs while supporting the top of the scapula. An alternative method of performing scapular manipulation involves the patient lying prone with forward traction provided by weights (e.g. 5 lbs) attached to the wrist of the affected arm, as in Stimson's technique. The scapula is then manipulated in the same fashion.
Additional simple techniques for reducing the dislocated shoulder also exist, including: the forward elevation maneuver, the modified gravity method, the crutch and chair technique, the chair and pillow technique, the external rotation method, and the snowbird reduction technique, among others.
Though these techniques are useful, it remains desirable to provide systems, methods, and apparatus for reducing a dislocated shoulder that do not require an intact lower arm or multiple people to reduce the shoulder.